Following repeated complaints of abdominal swelling for four years, after her third delivery, she was told that a large incisional hernia was present in her infraumbilical
region (situated below the navel).
The LAVH was performed in the usual fashion with an approximate 10 mm vertical infraumbilical
skin incision and placement of the trocar by an open technique.
Following undocking of the robot, a 4-cm infraumbilical
midline incision is made.
A single, curvilinear infraumbilical
incision was made followed by wide separation of the subcutaneous tissues off the linea alba.
Los cateteres fueron implantados con cirugia abierta a traves de la linea media infraumbilical
, con anestesia local y sedacion por lo que se realizaba de forma ambulatoria, no siendo necesario el ingreso.
CT scan of the abdomen and pelvis shows an infraumbilical
midline abdominal wall defect containing loops of small bowel (Figure 1) and free fluid in the pelvis (Figure 2).
Transversus abdominis plane (TAP) block is described in adults for lower abdominal surgery including radical prostatectomy (1), midline lower abdominal bowel surgery (2,3), appendicectomy (3,4), caesarean section (3,5-7), total abdominal hysterectomy (8), laparoscopic gynaecological surgery (9), inguinal hernia repair (10), for caesarean wound haematoma pain (11) and for laparoscopic cholecystectomy (with infraumbilical
Brill et al (26) documented a 27% incidence of adhesions via Pfannenstiel entry, a 55% incidence with a midline supraumbilical incision, and a 67% incidence following a midline infraumbilical
Operation time is time from making the infraumbilical
trocar incision to closing the incisions including the anastomosis time.
On physical examination he had a transverse infraumbilical
surgical incision scar and a pulsatile mass on his right lower quadrant of the abdomen with dermal bruits.
There was marked edema of the infraumbilical
abdominal skin with visible peau d'orange.
4) This is best accomplished through a small infraumbilical
incision, which allows inspection and repair of the bladder and proper placement of a large-bore catheter at the bladder dome.